Skip to main content

LMA for neonates Resus..


A study in Resuscitation looking at the efficacy of LMA’s in neonatal resuscitation. Usually we use a face mask and bag them.




This study shows a tiny LMA might be a better choice.

So get your LMA size 1 ready for the newborn resus trolley.



Objective: To study the feasibility, efficacy and safety of using the laryngeal mask airway (LMA) in neonatal resuscitation.

Methods: In total, 369 neonates (gestational age≥34 weeks, expected birth weight≥2.0 kg) requiring positive pressure ventilation at birth were quasi-randomised to resuscitation by LMA (205 neonates) or bag-mask ventilation (164 neonates).

Results: (1) Successful resuscitation rate was higher with the LMA compared with bag-mask ventilation (P < 0.001) and the total ventilation time was shorter with the LMA than with bag-mask ventilation (P < 0.001). Seven of nine neonates with an Apgar score of 2 or 3 at 1 min after birth were successfully resuscitated in the LMA group, while in the BMV group all six neonates with an Apgar score of 2 or 3 at 1 min required tracheal intubation and ventilation. In neonates with an Apgar score of 4 or 5 at 1 min after birth, successful resuscitation rate with the LMA was higher than with bag-mask ventilation (P < 0.01). (2) Successful insertion rate of the LMA at the first attempt was 98.5% and the insertion time was 7.8 s±2.2 s. There were few adverse events (vomiting and aspiration) in the LMA group.

Conclusion: The LMA is safe, effective and easy to implement for the resuscitation of neonates with a gestational age of 34 or, more weeks..

A prospective evaluation of the efficacy of the laryngeal mask airway during neonatal resuscitation, Resuscitation 2012.

Comments

Popular posts from this blog

The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by:   the area of the curve  the slope of the line from points C to D  the distance of the line from points C to D  the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by:  the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.

Driving Pressure in ARDS: A new concept!

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body